@article{fdi:010094877,
  title = {{C}entrifuge-free stool processing methods for {X}pert {MTB}/{RIF} {U}ltra tuberculosis diagnosis in children in {U}ganda and {Z}ambia : an observational, prospective, diagnostic accuracy study},
  author = {{L}ounnas, {M}anon and {M}asama, {E}. {N}. and {B}eneteau, {S}. and {K}asakwa, {K}. and {K}aitano, {R}. and {N}abeta, {P}. and {R}uhwald, {M}. and {D}e {H}aas, {P}. and {T}iemersma, {E}. {W}. and {N}duna, {B}. and {N}icol, {M}. {P}. and {E}yangoh, {S}. and {W}obudeya, {E}. and {M}wanga-{A}mumpaire, {J}. and {C}habala, {C}. and {M}arcy, {O}livier and {B}onnet, {M}aryline and {T}. {B}. {S}peed {S}tool {S}tudy {G}rp},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {WHO} recommends {X}pert {MTB}/{RIF} {U}ltra ({U}ltra) for stool testing for tuberculosis diagnosis in children. {S}tool processing requires removal of debris and {PCR} inhibitors, frequently by using centrifugation, which can be an implementation barrier for low-income and middle-income countries ({LMIC}s). {W}e evaluated the diagnostic accuracy of {U}ltra on stool using three centrifuge-free processing methods, the simple one-step ({SOS}), stool processing kit ({SPK}), and the optimised sucrose flotation ({OSF}) methods against a microbiological reference standard ({MRS}). {M}ethods {I}n this observational, prospective, multicountry, diagnostic accuracy study, we collected two respiratory samples and two stool samples in children younger than 15 years with presumptive tuberculosis in one hospital in {U}ganda and two hospitals in {Z}ambia for {U}ltra testing and culture (on respiratory samples only). {W}e defined positive {MRS} as positive culture or {U}ltra on respiratory sample and negative {MRS} as two negative respiratory samples by either culture or {U}ltra. {W}e assessed the perception of the laboratory operators of test ease-of-use using a self-administered questionnaire at all sites. {T}his study is registered with {C}linical{T}rials.gov ({NCT}04203628) and the {P}an {A}frican {C}linical {T}rial {R}egistry ({PACTR}202006814433059). {F}indings {O}f the 216 children enrolled between {J}an 13, 2020, and {D}ec 31, 2021, 215 were included in the study and of these 104 (48.4%) were female and 211 (51.6%) were male, the median age was 1.8 years ({IQR} 1.1-4.8), 68 (31.6%) were {HIV} positive, and 38 (17.7%) were {MRS} positive. {F}or one or both stool samples, depending on availability, the sensitivity of stool {U}ltra against {MRS} was 69.7% (95% {CI} 51.3-84.4) for {SOS}, 69.7% (51.3-84.4) for {SPK}, and 73.5% (55.6-87.1) for {OSF} ({M}c{N}emar test p>0.6 for all), with a specificity above 96% for all methods. {T}he {SOS} stool method was considered the easiest by six of seven operators because it required least manipulation and no additional reagents. {I}nterpretation {C}entrifuge-free stool processing methods could improve access to microbiological diagnosis of tuberculosis in {LMIC}s. {T}hese results contributed to the {WHO} endorsement of the {SOS} and {OSF} methods.},
  keywords = {{OUGANDA} ; {ZAMBIE}},
  booktitle = {},
  journal = {{L}ancet {M}icrobe},
  volume = {6},
  numero = {8},
  pages = {101055 [10 p.]},
  year = {2025},
  DOI = {10.1016/j.lanmic.2024.101055},
  URL = {https://www.documentation.ird.fr/hor/fdi:010094877},
}